Monitoring Microaggressions and Adversities to Generate Interventions for Change (MMAGIC) for Black Women Living with HIV

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Background: Black women represent the largest group of women with HIV, both nationally, and locally in Miami, a U.S. HIV epicenter; and 40% are not virally suppressed. Further, they live at the intersection of multiple marginalized identities and within social structures that take a daily toll. Microaggressions are every day and subtle insults via comments, jokes, and behaviors that are demeaning to a marginalized group (e.g. Black individuals, women, people living with HIV, LGBTQ+). Despite their frequency and potential importance, microaggressions have largely been ignored in the scientific literature on Black women living with HIV (BWLWH). Also, while scholars are beginning to investigate macroaggressions (discrimination acts such as denial of housing) and trauma/violence among women living with HIV, they are often only captured infrequently (e.g. annually) despite their re-occurring nature for this population. Preliminary work. We have further demonstrated the importance of studying microaggressions among BWLWH via an R56 that supported 1 year of research that this 4-year proposal will build on. We are finding high rates of microaggressions in BWLWH, and high rates of other adversities such as discrimination (macro acts) and reoccurring violence. These factors relate to mental health symptoms and health behaviors, but additional data over time is needed to understand their relationship specifically to viral suppression. Additionally, we are starting to understand the role of factors such as resilience, COVID-19, and the current U.S. racial climate. Conceptual Model: The conceptual model for Project MMAGIC (Monitoring Microaggressions and Adversities to Generate Interventions for Change) focuses on microaggressions and other adversities as negative predictors of HIV viral suppression (main outcome) mediated by mental health symptoms and health behaviors (ART adherence and engagement in care). We will longitudinally examine both potential direct effects and moderation by resilience factors at the individual (e.g. self-efficacy), interpersonal (e.g. social support), and neighborhood level (e.g. community health centers). By elucidating these pathways to viral suppression among BWLWH and having ongoing engagement with community partners, our findings will directly inform interventions. This proposal is precisely aligned with the NIH HIV/AIDS (high) Research Priority for supporting research to reduce health disparities in treatment outcomes of those living with HIV. Research Plan: 300 BWLWH will be enrolled in Miami (151 enrolled [4 lost] via R56 grant), and followed over 4 years. Data will be collected at assessment visits every 3 months on microaggressions, discrimination/macroaggressions, trauma and violence, mental health symptoms, medication adherence, engagement in care, viral suppression, and resilience factors. Given the daily nature of microaggressions, we will use an innovative text-message ecological momentary assessment methodology shown to be feasible (99% response rate) in our R56. Annually, we will gather information (using zip codes) from public data sources on neighborhood level resilience resources such as number and distance to community health centers and domestic violence shelters. Implications: The present study, occurring in the context of both COVID-19, and heighten visibility on racism in the U.S. presents an unfortunate yet unmatched important opportunity to study BWLWH in an HIV epicenter.